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Personal hygiene is something that only other people never seem to get quite right...Yet in this fascinating history of washing our bodies Katherine Ashenburg discovers that cleanliness exists above all in our minds: it is a cultural creation and a constant work in progress... Napoleon once wrote in a love letter to Josephine 'I return to Paris in five days. Stop washing.' To smell like a human was not always the misdemeanour it is today. Body odour was in fact an important factor of sex and courtship, considered by some to be a powerful aphrodisiac, as we see in Napoleon's letter. Contrary to what we like to think, no bodily odour is innately disgusting, instead it is our noses which adapt to fit our beliefs.The Romans would bathe in company and daily. Later, Europe underwent four centuries without a bath. Was it the threat of diseases like syphilis that it feared in the soapy water? Religion links the act of washing with forgiveness and regeneration. We wash the bodies of dead loved ones because somehow we imagine it as the end of the old and the beginning of the new. The history of washing our bodies reveals much about our intimate selves, about how we want to be seen and what we desire most...In this gripping new history, Ashenburg searches for clean and dirty in plague-ridden streets, hospitals, battlefields and makeshift water closets. In the bizarre prescriptions of history's doctors, the eccentricities of famous bathers and the hygienic peccadilloes of great writers we see the twists and turns that have brought us to our own, arbitrary notion of 'clean'.
What Is My Medical History?
When you fill out forms at your doctor’s office, do you wonder why it matters whether or not your grandmother had high blood pressure or diabetes? Your doctor also asks you questions like this. Why is it important?
Your medical history includes both your personal health history and your family health history. Your personal health history has details about any health problems you’ve ever had. A family health history has details about health problems your blood relatives have had during their lifetimes.
This information gives your doctor all kinds of important clues about what’s going on with your health, because many diseases run in families. The history also tells your doctor what health issues you may be at risk for in the future. If your doctor learns, for example, that both of your parents have heart disease, they may focus on your heart health when you’re much younger than other patients who don’t have a family history of heart disease.
Southern Historical Society Papers, Volume 20. Reverend J. William Jones, Ed.
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The Medical history of the Confederate States Army and Navy
[The historical value and interest of the following papers is manifest. Professor Joseph Jones , M. D., Ll.D., a born devotee to useful research and faithful demonstration is a representative of intrinsic worth, and beneficent life in several generations. He entered the Confederate States Army, modestly, as a private in the ranks, but in a short time his ability constrained his commission as a surgeon, and he was detailed by the able and astute Surgeon-General , Doctor S. P. Moore (whose useful services as a citizen of Richmond , is held in grateful memory), to investigate camp diseases, and the native remedial resources of the South , to supply a vital want which the Federal authorities had created by declaring medicine contraband of war. His own voluminous publications, the experience of the Confederate Medical Staff and published provision and results, attest the priceless value of his acumen and service. He was the first Secretary of the Southern Historical Society, organized in New Orleans, May 1, 1869, and it is held an honor by the present secretary, to be, in a line, his successor.] 
I Official Report of Joseph Jones , M. D., of New Orleans, Louisiana , Surgeon-General United Confederate Veterans, Concerning the Medical Department of the Confederate Army and Navy.
The Medical Department of the Confederate States was a branch of the War Department, and was under the immediate supervision of the Secretary of War . The Surgeon-General of the Confederate States was charged with the administrative details of the Medical Department —the government of hospitals, the regulation of the duties of surgeons and asssistant-surgeons, and the appointment of acting medical officers when needed for local or detached service. He issued orders and instructions relating to the professional duties of medical officers, and all communications from them which required his action were made directly to him. The great struggle for the independence of the Southern States ended twenty-five years ago, and all soldiers in the Confederate army, from the Commanding General to the private in the ranks, were, by the power of the conquering sword, reduced to one common level, that of paroled prisoners of war.
The objects of the Association of Confederate Veterans of 1890 are chiefly historical and benevolent. We conceive, therefore, that the labors of the Surgeon-General relate to two important objects.
First. The collection and preservation of the records of the Medical Corps of the Confederate Army and Navy.
Second. The determination by actual investigation and inquiry, the numbers and condition of the surviving Confederate soldiers who have been aisabled by wounds and diseases, received in their heroic defense of the rights and liberties of the Southern States .
To accomplish the first object, the following circular, No. 1, has been issued:
1. The Collection and Preservation of the Records of Medical Officers of the Confederate Army and Navy.
Circular no. I.
First. Name, nativity, date of commission in the Confederate States Army and Navy, nature and length of service of every member of the Medical Corps of the Confederate States Army and Navy.
Second. Obituary notice and records of all deceased members of the Medical Corps of the Confederate Army and Navy.
Third. The titles and copies of all field and hospital reports of the Medical Corps of the Confederate Army and Navy. 
Fourth. Titles and copies of all published and unpublished reports relating to military surgery, and to diseases of armies, camps, hospitals and prisons.
The object proposed to be accomplished by the Surgeon-General of the United Confederate Veterans , is the collection, classification, preservation and the final publication of all the documents and facts bearing upon the history and labors of the Medical Corps of the Confederates States Army and Navy during the civil war, 1861-‘65. Everything which relates to critical period of our national history, which shall illustrate the patriotic, self-sacrificing and scientific labors of the Medical Corps of the Confederate States Army and Navy, and which shall vindicate the truth of history, shall be industriously collected, filed and finally published. It is believed that invaluable documents are scattered over the whole land, in the hands of survivors of the civil war of 1861-‘65, which will form material for the correct delineation of the medical history of the corps which played so important a part in the great historic drama. Death is daily thinning our ranks, while time is laying its heavy hands upon the heads of those whose hair is already whitening with the advance of years and the burden of cares. No delay, fellow comrades, should be suffered in the collection and preservation of these precious documents.
To this task of collecting all documents, cases, statistics and facts relating to the medical history of the Confederate Army and Navy, the Surgeon-General of the United Confederate Veterans invites the immediate attention and co-operation of his honored comrades and compatriots throughout the South .
Respectfully, your obedient servant,
Formation of the Medical Corps of the Confederate Army and Navy.
Whilst political soldiers rose to power and wealth upon the shoulders of the sick and disabled soldiers of the Confederate army, by sounding upon all occasions ‘their war records,’ the modest veterans of the Medical Corps of the Confederate Army and Navy were content to serve their sick, wounded and distressed comrades, asking and receiving no other reward than that ‘peace which passeth all understanding,’ which flows from the love of humanity, springing from a generous and undefiled heart. It is but just and right that a Roll of Honor should be formed of this band of medical heroes and veterans.
Magnitude of the labors of the Medical Corps of the Con-federate Army and Navy.
Killed, wounded and prisoners of the Confederate Army.
During the period of nineteen months, January, 1862, July, 1863, inclusive, over one million cases of wounds and disease were entered upon the Confederate field reports, and over four hundred thousand cases of wounds upon the hospital reports. The number of cases of wounds and disease treated in the Confederate field and general hospitals were, however, greater during the following twenty-two months, ending April, 1865. It is safe to affirm, therefore, that more than three million cases of wounds and disease were cared for by  the officers of the Medical Corps of the Confederate Army during the civil war of 1861-1865. The figures, of course, do not indicate that the Confederacy had in the field an army approaching three millions and a half. On the contrary, the Confederate forces engaged during the war of 1861-1865 did not exceed six hundred thousand. Each Confederate soldier was, on an average, disabled for greater or lesser period, by wounds and sickness, about six times during the war.
Losses of the Confederate Army, 1861-1865.
|Confederate forces actively engaged during the war of 1861-1865||600,000|
|Grand total deaths from battle, wounds and disease||200,000|
|Losses of Confederate army in prisoners during the war on account of the policy of non-exchange adopted and enforced by the United States||200,000|
|Losses of the Confederate army from discharges for disability from wounds and disease and desertion during the years 1861-1865||100,000|
If this calculation be correct, one-third of all the men actually engaged on the Confederate side were either killed outright on the field or died of disease and wounds another third of the entire number were captured and held for indefinite periods prisoners of war and of the remaining two hundred thousand, at least one-half were lost to the service by discharges and desertion.
At the close of the war the available active force in the field, and those fit for duty, numbered scarcely one hundred thousand men.
The great army of Northern Virginia, surrendered by General Robert E. Lee on the 9th of April, 1865, could not muster ten thousand men fit for active warfare. Of this body of six hundred thousand men, fifty-three thousand seven hundred and seventy-three were killed outright, and one hundred and ninety-four thousand and twenty-six wounded on the battle-field. One third of the entire Confederate army was confided to the Confederate surgeons for the treatment of battle wounds and, in addition to such gigantic services, the greater portion, if not the entire body of the six hundred thousand men, were under the care of the medical department for the treatment of disease.
Well may it be said that to the surgeons of the medical corps is due the credit of maintaining this host of troops in the field. Such  records demonstrate, beyond dispute, the grand triumphs and glory of medicine, proving that the physician is the preserver and defender of armies during war.
These records show that the medical profession, however indispensable in the economy of government during peace, become the basis of such economy during war. These statistics show the importance of medicine and its glorious triumphs, and elevate it logically to its true position in the estimation of not only the physician, but in that also of the warrior and statesman. The energy and patriotic bravery of the Confederate soldier are placed in a clear light when we regard the vast armies of the Federals to which they were opposed.
The whole number of troops mustered into the service of the Northern army, during the war of 1861-1865, was two million seven hundred and eighty-nine thousand eight hundred and ninety-three, or about three times as large as the entire fighting population of the Confederate States . At the time of the surrender of the Confederate armies, and the close of active hostilities, the Federal force numbered one million five hundred and sixteen of all arms, officers and men, and equalled in number the entire fighting population of the Southern Confederacy.
Opposed to this immense army of one million of men, supplied with the best equipments and arms, and with the most abundant rations of food, the Confederate government could oppose less than one hundred thousand war-worn and battle-scarred veterans, almost all of whom had, at some time, been wounded, and who had followed the desperate fortunes of the Confederacy for four years with scant supplies of rations, and almost without pay and yet the spirit of the Confederate soldier remained proud and unbroken to the last charge, as was conclusively shown by the battles of Franklin and Nashville, Tennessee the operations around Richmond and Petersburg the last charge of the Army of Northern Virginia the defense of Fort McAllister on the Ogeechee river in Georgia , where two hundred and fifty Confederate soldiers, in an open earthwork, resisted the assaults of more than five thousand Federal troops, and never surrendered, but were cut down at their guns at West Point, Georgia , where there was a similar disparity between the garrison and the assaulting corps, where the first and second in command were killed, and the Confederates cut down within the fort the defense of Mobile in Alabama , and the battle of Bentonville in North Carolina .
Number of officers and Roster of the Medical Corps of the Confederate Army and Navy.
A general estimate of the aggregate number of medical officers employed in the Medical Department of the Southern Confederacy may be determined by the number of commissioned officers in the Confederate army down to the rank of lieutenant-colonel. Each regiment in the Confederate army was entitled to one colonel, one surgeon, and one or two assistant surgeons , and a medical officer was generally attached to each battalion of infantry, cavalry or artillery. Generals , lieutenant-generals , major-generals and brigadier-generals, frequently, if not always, had attached to their staff medical directors, inspectors or surgeons of corps, divisions and brigades.
We gather the following figures from the elaborate and invaluable ‘Roster of General Officers , etc., in Confederate Service,’ prepared from official sources by Colonel Charles C. Jones , Jr. , of Augusta, Georgia . 1
Confederate States Army.
|Confederate States Army-Regular and Provisional:|
If it be estimated that for each of these officers, one surgeon and two assistant-surgeons were appointed, and served in field and hospital, then the Confederate Medical Corps was composed of about the following:
This estimate places the number of surgeons and assistantsur-geons at too high a figure, as may be shown by the following considerations:
a. Many regiments and battalions had not more than two medical officers .
b. The casulties of war were much more numerous, and promotion was much more rapid, amongst the line officers than in the Medical Staff .
A more accurate estimate of the actual number of medical officers actively engaged in the Confederate army during the war 1861-‘65, may be based upon the number of regiments, battalions and legions of infantry, cavalry and artillery, furnished by the individual States, during the civil war:
|Total number of regiments—infantry||536|
|Total number of regiments—cavalry||124|
|Total number of regiments—artillery||13|
These regiments were furnished by the individual States, as follows:
|Grand total regiments||673|
|Total number of battalions — infantry||67|
|Total number of battalions — cavalry||28|
|Total number of battalions — artillery||50|
|Total legions — infantry||13|
|Total legions — cavalry||3|
|Total legions — artillery|
|Total battalions and legions||161|
|Total regiments, battalions and legions comprising the Confederate army during the war 1861-1865||834|
If one surgeon and two assistant-surgeons be allowed to each separate command actively engaged in the field during the civil war, 1861-1865, the numbers would be as follows:
The medical officers of the Confederate navy numbered:
|Total medical officers C. S. N||73|
If to the above be added the surgeons of the general hospitals, recruiting and conscript camps, the entire number of medical officers in the Confederate army during the war 1861-1865 did not amount to three thousand.
The Surgeon-General of the United Confederate Veterans has endeavored to construct an accurate roster from his labors in the field and hospital during the war, and from the official roll of the Confederate armies in the field, and thus far he has been able to record the names and rank of near two thousand Confederate surgeons and assistant-surgeons.
The official list of the paroled officers and men of the Army of Northern Virginia, surrendered by General Robert E. Lee , April 9th, 1865, furnished three hundred and ten surgeons and assistant-surgeons.
The co-operation in this most important work is solicited from every surviving member of the Medical Corps of the Southern Confederacy.
When perfected, this Roster will be published as a roll of honor and deposited in the archives of the United Confederate Veterans .
The determination of the number and condition of the surviving Confederate soldiers who were disabled by the wounds and diseases received in the Defence of the rights and Liberties of the Southern States .
Circular no. 2.
1. The number of troops furnished to the Confederate States by the State of——.
2. Number of wounded during the civil war 1861-1865.
3. Number of killed during the civil war 1861-1865.
4. Number of deaths by wounds and disease.
5. Number of Confederate survivors now living in the State of——.
6. The amount of moneys appropriated by the State of——for the relief and support of the survivors of the Confederate Army from the close of the civil war in 1865 to the present date, 1890.
7. Name, location and capacity of all establishments, hospitals or homes, devoted to the care of maimed, sick and indigent survivors of the Confederate States Army.
8. A detailed statement of the moneys expended by the State of ——for the support of the maimed, disabled and indigent survivors of the Confederate Army.
Respectfully, your obedient servant,
The Southern States are morally bound to succor and support the men who were disabled by the wounds and diseases received in their service, and the widows and orphans of those who fell in battle.  The Confederate soldiers who engaged in the struggle for constitutional liberty and the right of self-government were neither rebels nor traitors they were true and brave men, who devoted their fortunes and their lives to the mothers who bore them, and their precious blood watered the hills, valleys and plains of their native States, and their bodies sleep in unknown graves, where they shall rest until the last great trumpet shall summon all alike, the conquered and the conqueror.
The survivors have no government with its hundreds of millions for pensions in the loneliness and suffering of advancing years and increasing infirmities, they can look alone to the States which they served so faithfully in battle, in victory and in defeat.
The noble soldiers who composed the illustrious armies of Northern Virginia and Tennessee made a gallant fight against overwhelming odds for what they believed to be sacred rights and constitutional liberty. The contest was decided by the sword against them.
These matchless soldiers accepted the issue in good faith they returned to their homes they resumed the avocations of peace, and engaged in building up the broken fortunes of family and country. These brave soldiers have discharged the obligations of good and peaceful citizens as well as they had performed the duties of thorough soldiers on the battle-field. It has been well said that no country ever produced braver or more intelligent and chivalric soldiers or more industrious, law-abiding and honorable citizens than were the soldiers who surrendered with the Confederate flag. The earth has never been watered by nobler or richer blood than that shed by those who fell beneath its folds.
I have the honor, General, to remain
II. brief report of the First reunion of the survivors of the Medical Corps of the Confederate Army and Navy, July 2, 1890, in N. B. Forrest Camp, Chattanooga, Tennessee —Address of Surgeon-General Joseph Jones , M. D., United Confederate Veterans , containing war statistics of the Confederate armies of Mississippi and Tennessee also casulties of battles of Belmont , Donelson , Shiloh , Perryville , Murfreesboro , Chickamauga engagements from Dalton to Atlanta battles around Atlanta , Jonesboro , Franklin and Nashville .
Surgeon Drake introduced Joseph Jones , M. D., of New Orleans, Surgeon-General of the United Confederate Veterans , who spoke as follows:
As the speaker stood this day upon the summit of Lookout Mountain , at an elevation of two thousand six hundred and seventy-eight feet, the mountains and valleys of Tennessee and Georgia presented a panorama of wonderful beauty and unsurpassed historical interest. At the foot of the mountain, which stands silent and alone, like the Egyptian Sphinx , winds the beautiful Tennessee , embracing the growing and active city of Chattanooga , like a crown of jewels, spreading around and over Cameron's Hill, once crowned with stern battlements and frowning cannon. Here at our feet lies Moccasin Bend, as beautiful as a garden with its fields of waiving grain. Up  this steep mountain side charged the Northern hosts, and here was fought ‘The Battle Above the Clouds.’ The eye ranges over Waldron's Ridge and Missionary Ridge , rendered historic by bloody and desperate battles. Twenty-seven years ago the soldiers of General Bragg , ranged along the crest of Lookout Mountain and Missionary Ridge , held the Northern army closely invested within the military and fortified camp of Chattanooga, and sustaining upon their bayonets the fortunes of the Southern Confederacy in the West , they resisted the southward flow of the red tide of war, and for a time protected the mountains, hills and valleys of Georgia from the devastating march of Northern hostile armies.
Battle of Chickamauga , Georgia .
The battle of Chickamauga , Georgia , is justly regarded as one of the most bloody conflicts of the war.
General Bragg 's effective force on the first day of the battle, September 19, 1863, exclusive of cavalry, was a little over thirty-five thousand men, which was in the afternoon reinforced by five brigades of Longstreet 's corps numbering about five thousand effective infantry, without artillery. The Confederate loss was in proportion to the prolonged and obstinate struggle, and two-fifths of these gallant troops were killed and wounded.
Dr. A. E. Flewellen , the Medical Director of the Army of Tennessee, who is with us at this reunion, active and energetic in body and mind, at the age of seventy years, gave the following estimate of the Confederate losses in this bloody battle of Chickamauga :
Battle of Chickamauga —Confederate losses.
The full and revised returns of all the Confederate forces engaged in this bloody battle show that the estimate of the Medical Director of the casulties was below and not above the actual loss.
The aggregate casulties of the 19th and 20th of September, 1863, were officially reported by General Braxton Bragg , as two thousand and twelve killed, twelve thousand nine hundred and ninety-nine wounded, and two thousand and eighty-four missing total, seventeen thousand and ninety five.
From the original reports in the possession of General Braxton Bragg , we consolidated the following:
On the 19th of September, Lieutenant-General Polk 's corps numbered thirteen thousand three hundred and thirteen effective officers and men, artillery and infantry on the 20th, eleven thousand and seventy-five. During the two days battle, Polk 's corps lost, killed four hundred and forty-two, wounded three thousand one hundred and forty-one, missing five hundred and thirty-one total four thousand one hundred and fourteen.
On the 19th of September, Lieutenant-General Longstreet 's corps numbered two thousand one hundred and eighty-nine on the 20th, seven thousand six hundred and thirty-five loss, killed four hundred and seventy-one, wounded two thousand eight hundred and eighty-seven, missing three hundred and eleven total three thousand six hundred and sixty-nine.
Lieutenant General D. H. Hill 's corps numbered, September 19th, seven thousand one hundred and thirty-seven on the 20th, eight thousand eight hundred and twelve loss, killed three hundred and eighty, wounded two thousand four hundred and fifty-six, missing one hundred and sixty eight total three thousand and four.
Major-General S. B. Buckner 's corps numbered, September 19th, nine thousand and eighty on the 20th, six thousand nine hundred and sixty-one loss, killed three hundred and seventy-eight, wounded two thousand five hundred and sixty-six, missing three hundred and forty-one total three thousand two hundred and eighty-five.
Major-General W. H. F. Walker 's corps, September 19th, seven thousand five hundred and thirty-seven 20th, five thousand nine hundred and seventy-four loss, killed three hundred and forty-one, wounded one thousand nine hundred and forty-nine, missing seven hundred and thirty-three total three thousand and twenty-three.
On the 19th of September the number of Confederate officers and men engaged were: 
|Infantry enlisted men.||34,096|
|Total infantry and artillery.||39,306|
On the 20th of September the number of Confederate officers and men engaged were:
|Total infantry and artillery||40,457|
Total officers and men killed, wounded and missing, artillery and infantry, September 19 and 20, 1863: killed, two thousand and twelve wounded, twelve thousand nine hundred and ninety-nine missing, two thousand and eighty-four total, seventeen thousand and ninety-five.
Right wing, commanded by lieu't General Leonidas Polk .
|Polk 's corps||442||3,141||531||4,114|
|Hill 's corps||380||2,456||168||3,004|
|Wallker 's corps||341||1,949||733||3,023|
Left wing, Lieutenant-General James Longstreet .
|Longstreet 's corps||471||2,887||311||3,669|
Grand total right and left wing: killed, two thousand and twelve wounded, twelve thousand nine hundred and ninety-nine missing, two thousand and eighty-four: total, seventeen thousand and ninety-five.
Nearly one-half of the army consisted of reinforcements, just before the battle without a wagon or an artillery horse, and nearly if not quite one-third of the artillery horses were lost on the field the medical officers had means greatly inadequate, especially in transportation, for the great number of wounded suddenly thrown upon their hands, in a wild and sparsely settled country many of the wounded were exhausted by two days battle, with limited supply of water, and almost destitute of provisions.
The fruits of this glorious victory, purchased by an immense expenditure of the precious blood of the Southern soldiers, were lost to the Southern Confederacy through the indecision and indiscretion of the Confederate commander.
Casualties of the Army of Tennessee, November, 1863.
The losses of the Confederate forces were:
Knoxville , November 18 to 29—Killed, two hundred and sixty wounded, eight hundred and eighty total, one thousand one hundred and forty.
Lookout Mountain , November 23 and 24—Killed, forty-three: wounded, one hundred and thirty-five total, one hundred and seventy-eight.
Missionary Ridge , November 25, 1863—Killed, three hundred and eighty-three wounded, one thousand eight hundred and eighty-two total, two thousand two hundred and sixty-five.
Tunnel Hill , November 27—Killed, thirty wounded, one hundred and twenty-nine total, one hundred and fifty-nine.
Aggregate of these engagements—Killed, seven hundred and sixteen: wounded, three hundred and two total, three thousand seven hundred and forty-two.
We have, then, as a grand aggregate of the Confederate losses in battle in the operations around Chattanooga, Tennessee : 
|Battle of Chickamauga , Georgia , September 19 and 20||2,012||12,999||2,087|
|Knoxville , Lookout Mountain , Missionary Ridge , Tunnel Hill , Nov. 18, 29||716||3,026|
This estimate does not include the losses in prisoners sustained by General Bragg 's army at Knoxville , at Lookout Mountain and Missionary Ridge , which would swell the total loss to over thirtythou-sand men.
The desperate and bloody nature of the Confederate operations around Chattanooga , in the months of September and November, 1863, will be seen by a brief view of the preceding great battles fought by the armies of Mississippi and Tennessee , and of the subsequent campaigns under General Joseph E. Johnston and General J. B. Hood , in 1864 and 1865.
At the battle of Belmont , Missouri , on the 7th November, 1861, the Confederate forces, under the command of General Leonidas Polk , defeated the Federal forces under General U. S. Grant , with a loss to the former of killed, one hundred and five wounded, four hundred and nineteen missing, one hundred and seventeen total, six hundred and forty-one.
The Confederate operations of 1861 and 1862, as conducted by General Albert Sidney Johnston , at the battle of Shiloh , were characterized by the most appalling disasters.
Fort Henry, Tennessee , fell February 6, 1862, with an insignificant loss of five killed, eleven wounded, sixty-three prisoners.
Fort Donelson, Tennessee , after three days fighting, February 14, 15 and 16, 1862, surrendered, with a loss of killed, two hundred and thirty-one wounded, one thousand and seven prisoners, thirteen thousand eight hundred and twenty-nine total Confederate loss, fifteen thousand and sixty-seven. With the fall of Forts Henry and Donelson , the Cumberland and Tennessee were opened to the passage of the iron-clad gunboats of the Northern army Kentucky passed under the Federal yoke Nashville , the proud political and  literary emporium of Tennessee , was lost, and this noble State became the common battle-ground of hostile and contending armies.
Both sides levied recruits and supplies from the unfortunate citizens of Tennessee Columbus, Kentucky , was abandoned, and the fall of Island No.10 , Fort Pillow and Memphis followed.
The unbroken tide of Federal victory in the West was rudely arrested by the armies gathered by General Albert Sidney Johnston and General G. T. Beauregard near the southern shore of the Tennessee , at Corinth, Mississippi .
The brave Confederate commander, General Albert Sidney Johnston sealed his devotion to the Southern Confederacy with his life, on the 6th of April, 1862, whilst leading to victory the gallant soldiers of the Armies of Mississippi and Tennessee .
At the battle of Shiloh , April 6 and 7, 1862, the effective total of the Confederate forces, comprising the Army of Mississippi, before the battle, numbered, forty thousand three hundred and fifty-five, and after the bloody repulse of the 7th, the effective total was only twenty-nine thousand six hundred and thirty-six. General Beauregard , in his official report, places his loss at Shiloh at one thousand seven hundred and twenty-eight killed outright, eight thousand nine hundred and twelve wounded, nine hundred and fifty-nine missing, making an aggregate of casualties of ten thousand six hundred and ninety-nine.
The losses at Shiloh were distributed among the different corps of the Confederate army as follows:
|First Corps, Major-General Polk||385||1,953||19|
|Second Corps, Major-General Bragg||553||2,441||634|
|Third Corps, Major-General Hardee||404||1,936||141|
|Reserve, Major-General Breckenridge||386||1,682||165|
The suffering of the Confederate wounded were great, indeed, as they lay upon the cold ground of Shiloh during the night of the 6th, exposed to the pitiless rain and the murderous fire of the gunboats. In the subsequent siege of Corinth , less than fifty thousand Confederate troops successfully resisted the advance of one hundred and twenty-five thousand Federal troops abundantly supplied with food and water, and armed and equipped with most approved weapons of modern warfare. 
The losses of the Confederate forces from disease during the siege of Corinth equalled, if they did not exceed, the casualties of the battle of Shiloh .
General Beauregard , by his masterly evacuation of Corinth , eluded his powerful antagonist. The Armies of Mississippi and Tennessee , under the leadership of General Bragg , inaugurated the campaign of 1862 for the recovery of Tennessee and Kentucky .
At the battle of Perryville , Kentucky , October 8, 1862, the Army of Mississippi, under the command of General Leonidas Polk , lost, killed, five hundred and ten wounded, two thousand six hundred and thirty-five missing, two hundred and fifty-one total, three thousand three hundred and ninety-six.
In the Kentucky campaign of 1862, the Confederate troops under the command of Generals Braxton Bragg and E. Kirby Smith manifested their powers of endurance on long and fatiguing marches, and their excellent discipline in retreating in good order in the face of overwhelming hostile forces.
At the battle of Murfreesboro , December 31, 1862, and January 1, 1863, the Confederate army lost nearly one-third of its number in killed and wounded.
General Bragg , in his official report of this battle, estimates the number of his fighting men in the field on the morning of the 31st of December at less than thirty-five thousand, of which about thirty thousand were infantry and artillery. During the two days fighting General Bragg 's army lost one thousand six hundred killed and eight thousand wounded total, nine thousand six hundred killed and wounded.
From the 6th of April, 1862, to the close of the year 1863, the Army of Mississippi and Tennessee lost in the battles of Shiloh , Murfreesboro and Chickamauga six thousand and forty-six killed on the field, and thirty-two thousand and thirty-five wounded total killed and wounded, thirty-eight thousand and eighty-one.
We do not include in this estimate the loss sustained at Perryville , in Bragg 's Kentucky campaign, or in numberless skirmishes and cavalry engagements. More than fifty thousand wounded men were cared for by the medical officers of the Army of Tennessee during a period of less than twenty-one months.
The deaths from disease exceeded those from gun-shot wounds, and the sick from the camp diseases of armies greatly exceeded the wounded, in the proportion of about five to one and during the  period specified, embracing the battles of Shiloh and Chickamauga , the sick and wounded of the Armies of Tennessee and Mississippi numbered more than two hundred thousand.
Surely from this mass of suffering humanity, valuable records and practical precepts in the practice of medicine and military surgery must have been evolved. It was and is the solemn duty of every member of the Medical Corps of the Army of Tennessee to place the results of his experience in a tangible form, accessible to his comrades and no officer, however important his position during the Confederate struggle, has the right to withhold for his personal benefit the Hospital and Medical Records of the Army of Tennessee. These views are applicable to the medical and surgical statistics of the several armies of the rate Confederacy east and west of the Mississippi .
The Armies of Tennessee and Mississippi , under the command of General Joseph E. Johnston , sustained a loss of killed, one thousand two hundred and twenty-one, wounded, eight thousand two hundred and twenty-nine total, nine thousand four hundred and fifty—in the series of engagements around and from Dalton, Georgia , to the Etowah river , May 7th to May 30th, 1864 series of engagements around New Hope Church, near Marietta , June 1, July 4, 1864.
The Army of Tennessee (the Army of Mississippi being merged into it), under the command of General J. B. Hood , during the series of engagements around Atlanta and Jonesboro July 4 to September 1, 1864, loss, killed, one thousand eight hundred and twenty-three, wounded, ten thousand seven hundred and twenty-three total, twelve thousand five hundred and forty-six.
During a period of four months the Armies of Tennessee and Mississippi fought no less than six important battles, and sustained a loss of killed, three thousand and forty-four, wounded eighteen thousand nine hundred and fifty-two. Total killed and wounded, twenty-one thousand nine hundred and ninety six.
During the month of October, 1864, the Army of Tennessee lost killed, one hundred and eighteen wounded, six hundred and twenty-two total, seven hundred and forty. During the month of November: Killed, one thousand and eighty-nine wounded, three thousand one hundred and thirty-one total, four thousand two hundred and twenty. These casualties include the bloody battle of Franklin , Tennessee , fought November 30, 1864. 2 
As shown by Colonel Mason 's official report, made on the 10th of December, ten days after the battle of Franklin , the effective strength of the Army of Tennessee was: Infantry, eighteen thousand three hundred and forty-two artillery, two thousand four hundred and five cavalry, two thousand three hundred and six total, twenty-three thousand and fifty-three. This last number, subtracted from thirty thousand six hundred, the strength of General Hood 's army at Florence , shows a total loss, from all causes, of seven thousand five hundred and forty-seven from the 6th of November to the 10th of December, which period embraces the engagements at Columbia , Franklin , and of Forrest 's cavalry. 3
At the battle of Nashville , the Army of Tennessee lost in killed and wounded about two thousand five hundred, making the total loss during the Tennessee campaign about ten thousand.
According to Colonel Mason 's statement, there were, including the furloughed men, about eighteen thousand five hundred men, effectives, of the infantry and artillery at Tupelo after General Hood 's retreat from Nashville . Before the advance of the army into Tennessee on the 6th of November, 1864, the effective strength was thirty thousand six hundred, inclusive of the cavalry.
Thus we find at Tupelo , eighteen thousand five hundred infantry and artillery, and two thousand three hundred and six Forrest 's cavalry, to which add ten thousand lost from all causes, and the total sum amounts to thirty thousand eight hundred and six effectives. General Hood thus estimates his loss in the Tennessee campaign to have been in excess of ten thousand.
Of the once proud Army of Tennessee, less than twenty thousand foot-sore, shoeless, ragged soldiers escaped with Hood 's advance into Tennessee at the same time a large army (in numbers at least) of sick, wounded and convalescents crowded the general hospitals in Georgia , Alabama and Mississippi .
The life of the Confederacy was bound up in its armies, and when these armies were scattered in the field and their means of sustenance and transportation destroyed, all hope of final success perished. With the Southern Confederacy, the problem was one of endurance and resources and no Confederate general appears to have comprehended this truth more thoroughly than Joseph E. Johnston . In his masterly retreat from Dalton to Atlanta , he opposed successfully  less than fifty thousand Confederate troops against General Sherman 's powerful, thoroughly armed and equipped army of more than one hundred thousand brave, stalwart Western soldiers. In his slow retreat, General Johnston was ever ready to give battle, and whilst inflicting greater losses upon his great adversary than his own forces sustained, he, nevertheless, during this incessant fighting maintained the morale, discipline, valor and thorough organization and armament of his soldiers.
The chief executive of the Southern Confederacy, with all his lofty patriotism and burning ardor for the defence of his bleeding country, placed too high an estimate upon his own individual military genius, and failed to grasp in all its bearings the problem of the terrible death struggle of the young nation.
General Hood combined with unbounded energy and dauntless courage and glowing patriotism a fiery ambition for military glory which led him to overestimate his own military genius and resources and at the same time to underestimate the vast resources and military strategy of his antagonist.
When General Hood ceased to confront General Sherman , and opened the way for his desolating march through the rich plantations of Georgia , the Empire State of the South , the fate of the Confederacy was forever sealed. The beleagured Confederacy, torn and bleeding along all her borders, was in no position to hurl her war-worn, imperfectly clad and poorly armed and provisioned battalions upon fortified cities.
The effort to destroy forces aggregating in Georgia and Tennessee near two hundred thousand effectives by a force of less than forty thousand men, which had cut loose from its base of supplies, exceeded the wildest dream of untamed military enthusiasm.
Of the gallant soldiers whose blood reddened the waters of the Tennessee and enriched the hills and valleys of Georgia , Tennessee furnished seventy regiments of infantry and twelve regiments of cavalry.
If the soldiers furnished by Tennessee to the Federal army be added, it is only just to say that she alone furnished more than one hundred thousand men to the American war of 1861-‘65, and won afresh the title of the Volunteer State.
Noble Tennessee ! The generous and prolific mother of brave soldiers and of beautiful and intrepid women.
What changes have been wrought in a quarter of a century! The songs of birds, the sturdy blows of the woodman's axe have supplanted  the roar of cannon and the rattle of musketry the soil which drank up the blood of Southern soldiers bears its precious burden of golden corn and snowy white fleecy cotton the laughter of women and prattle of children, and the merry whistle of the plowman fill the places of the brazen trumpet and the martial music of the fife and drum, and the hoarse shouts of contending men, and groans of the wounded and dying the entrenched camp and ragged village of 1865 has given place to the thriving city of fifty thousand inhabitants, with its workshops, factories, well filled stores, electric lights and railways, and its universities of science and literature.
Here in this historic place the weary invalids of the Northern clime may rest in the shadows and bathe their fevered brows in the cool breezes of these grand mountains.
In this brief record of the heroic efforts of the soldiers of the Armies of Mississippi and Tennessee to defend the Southern States from the Northern invaders, we have time but to make a brief allusion to the defence of the Mississippi river by the Confederate Government, which was characterized by a long chain of disasters.
The fall of Forts Henry and Donelson opened the Cumberland and Tennessee rivers to the iron clads of the Federals and convoyed and protected their armies as they marched into the heart of the Confederacy . The strong fortifications erected by General Leonidas Polk , at Columbus, Kentucky , were evacuated by the orders of the commanding Generals , Albert Sidney Johnston and G. T. Beauregard .
Island No.10 fell with a loss of seventeen killed and five hundred prisoners, on the 8th of April, 1862, and the navigation of the Mississippi river was secured by the Federal fleet up to the walls of Fort Pillow , above Memphis, Tennessee .
New Orleans, the commercial emporium of the Confederacy , fell after an inglorious defence (April 18, April 28, 1862), characterized by indecision, incompetence and insubordination, with the trifling loss of one hundred and eighty-five killed, one hundred and ninety-seven wounded, four hundred prisoners total Confederate loss, seven hundred and eighty-two.
Wise statesmanship dictated that the entire power and resources of the Southern Confederacy should have been concentrated upon the defence of the mouth of the Mississippi river . The future historian of this war will find in the tall of Forts Henry , Donelson , and of New Orleans the first and greatest disasters of the Southern cause from which unnumbered and fatal disasters flowed, and which ended in the final destruction of the Confederacy . 
The evacuation of Fort Pillow was followed by the surrender at Memphis, Tennessee , June 6, 1862, after a loss of eighty-one killed and wounded, and one hundred missing, incurred in the resistance offered by the Confederate flotilla, consisting of the gunboats Van Dorn , Price , Jeff Thompson , Bragg , Lovell , Beauregard , Sumpter and Little Rebel .
The defence of Vicksburg includes: The battle of Baton Rouge , August 5, 1862, General J. Breckenridge : killed, eighty-four wounded, three hundred and sixteen missing, seventy-eight total Confederate loss, four hundred and sixty-eight. Iuka, Mississippi , September 19 and 20, General Sterling Price : killed, two hundred and sixty-three wounded, six hundred and ninety-two missing, five hundred and sixty-one total, one thousand five hundred and sixteen. Corinth, Mississippi , October 3 and 4, 1862, Generals Van Dorn and Sterling Price : killed, five hundred and ninety-four wounded, two thousand one hundred and sixty-two missing, two thousand one hundred and two total, four thousand eight hundred and six. Port Gibson , May I, 1863, Major-General John S. Bowen : killed and wounded, one thousand one hundred and fifty missing, five hundred total, one thousand six hundred and fifty. Baker's Creek , May 16, 1863, Lieutenant-General Pemberton : killed and wounded, two thousand missing, one thousand eight hundred total, three thousand eight hundred. Big Black River , May 17, 1863, Lieutenant-General Pemberton : killed and wounded, six hundred missing, two thousand five hundred total, three thousand one hundred and ten. Vicksburg, Mississippi , May 18 to July 4, 1863: Lieutenant-General J. C. Pemberton : killed, wounded, missing and prisoners, thirty-one thousand two hundred and seventy-seven. Port Hudson, Louisiana , May 27 to July 9, 1863 killed and wounded, seven hundred and eighty: missing and prisoners, six thousand four hundred and eight total, seven thousand one hundred and eighty-eight. Jackson, Mississippi , July 9 to 26, General Joseph E. Johnston : killed, seventy one wounded, five hundred and four missing, twenty-five total, six hundred.
During the operations in Mississippi and Louisiana on the east bank of the Mississippi river for the defence of Vicksburg , commencing with the battle of Baton Rouge , August 5, 1862, and ending with the evacuation of Jackson, Mississippi , July 19, 1863, the Confederate army lost in killed, wounded and prisoners, fifty-four thousand four hundred and fifteen officers and men—an army equal in numbers to the largest ever assembled upon any battle-field of the  war under any one Confederate commander. If we add to this the losses occurring in the field and general hospitals, from sickness, discharges, deaths and desertions, the loss sustained by the Confederate forces in these operations would equal an army of at least seventy-five thousand.
The heart of the Southern patriot stands still at the recital of these humiliating details. The Confederate commander, General J. C. Pemberton , was not merely outnumbered, but he was outgeneraled by his Northern antagonists.
What medical and surgical records have been preserved of this mass of suffering, disease and death? Who has written the medical history of the sufferings of the brave defenders of Vicksburg ?
Fellow soldiers and comrades of the Confederate Army and Navy, I accepted the honor conferred upon me by one of the most illustrious captains of the struggle for Southern independence, not because it conferred power or pecuniary emoluments, but solely that I might in some manner further the chosen project of my life. When my native State, Georgia, seceded from the Federal union in January, 1861, I placed my sword and my life at her service. Entering as a private of cavalry, I served in defense of the sea coast in 1861, and although acting as surgeon to this branch of the service, I performed all the duties required of the soldier in the field. Entering the medical service of the Confederate army in 1862, I served as surgeon up to the dale of my surrender in May, 1865. Through the confidence and kindness of Surgeon-General S. P. Moore , Confederate States Army, I was enabled to inspect the great armies, camps, hospitals, beleagured cities and military prisons of the Southern Confederacy.
The desire of my soul, and the ambition of my entire life, was to preserve, as far as possible, the medical and surgical records of the Confederate army during this gigantic struggle.
The defeat of our armies and the destruction of our government only served to increase my interest and still further to engage all my energies in this great work, which, under innumerable difficulties, I have steadily prosecuted in Augusta, Georgia , Nashville, Tennessee , and New Orleans, Louisiana , up to this happy moment when I greet the stern but noble faces of the survivors of the Confederate Army and Navy.
I hold this position, which has neither military fame nor financial resources, solely for the right which it gives me to issue a last appeal for the preservation of the Medical and Surgical Records of the Medical Corps of the Confederate Army and Navy. 
A veteran of more than four years active service in the cause of the Southern Confederacy, at the end of a quarter of a century issues his last call of honor and glory to his comrades, which will be found at length in his report to the general commanding, which is now presented for the consideration of the survivors of the Medical Corps of the Confederate Army and Navy. (See preceding report.)
With the researches and records of the speaker taken during the war and subsequently, he has in his possession ample material for a volume relating to the Medical and Surgical History of the Confederate Army of not less than one thousand five hundred pages, and it is to be hoped that the survivors will furnish such data as will enable him to give accurate statements with reference to the labors, names and rank of the medical officers .
Insignia of the Medical Corps of the Confederate Army and Navy.
The objects of this reunion and of this association are historical, benevolent and social, and the medal or seal which marks its realization should embody within a brief circle these sacred and noble sentiments.
The outer circle bearing the words ‘Medical Corps Confederate States of America , Army and Navy, 1861-1865,’ expresses the great historical fact, that within the circle of these four years a nation was born and exhibited to the world its existence, power and valor, in its well organized and efficient army and navy. Within the brief space of time, 1861-1865, was enacted one of the greatest and bloodiest revolutions of the ages, and a peculiar form of civilization passed forever away.
Upon the silver field and embraced by the outer circle rests a golden cross with thirteen stars—the Southern cross—the cross of the battle flag of the Southern Confederacy.
The reverse of the medal bears at the apex of the circle the letters U. C. V., and at the line under, the date 1890. The laurel leaf of the outer circle surrounds the venerated and golden head of the great Southern captain, General Robert E. Lee , who was the type of all that was heroic, noble and benevolent in the Confederate Army and Navy. Grand in battle and victory, General Lee was equally grand  and noble in defeat and his farewell address to his soldiers has been the most powerful utterance for the pacification of the warlike elements of his country and the rehabilitation of the waste places of the South by the peaceful arts of agriculture, manufacturers and commerce.
Whilst the Southern armies were wreathed in victory, the thunderbolts of war, which made wide gaps through their ranks, inflicted irreparable damage. When the brave soldiers of the South sank to rest upon the bosom of their mother earth, they rose no more the magnificent hosts which watered the plains, valleys and mountains with their precious blood were the typical and noble representatives of their race.
Whilst the North increased in resources and men, as the war went on, the Southern Confederacy was penetrated and rent along all her borders her fertile plains were overrun and desolated, her gallant sons fell before the iron tempest of war, and her final overthrow and subjugation followed as the night does the day.
Comrades, survivors of the Medical Corps of the Confederate Army and Navy, is it not our solemn duty to commemorate the deeds of our comrades who yielded up their lives in the struggle for Southern independence, on the battle-field, in the hospital and in the military prison? Shall we not adopt a simple but imperishable medal which may be handed down to our children?
Organization of a Medical relief Corps during the reunion of the United Confederate Veterans , at Chattanooga, Tennessee , July 2, 3, and 4, 1890.
The following physicians were appointed and requested to go on duty and act as a Medical Relief Corps, at the places designated, during the 3d, 4th and 5th of July, beginning at 8 A. M. each day. They will be relieved hourly, and take their turns in the order named:
Joseph Jones , Surgeon-General United Confederate Veterans. G. W. Drake , Medical Director . P. D. Sims , Chief of Staff . L. H. Wilson , Register.
All visiting physicians and surgeons of the Confederate States Army and Confederate States Navy, are requested to register at L. H. Wilson 's drug store, 829 Market street.
After the committee was appointed, Dr. Jones , read his report to General John B. Gordon , Commander United Confederate Veterans.
Dr. J. E. Reeves delivered a short address, in which he complimented Dr. Jones very highly on the manner and thoroughness of his report, and in conclusion offered a motion to appoint a committee to draft suitable resolutions in regard to Dr. Jones ' report. The following gentlemen composed the committee: Drs . Drake , Holtzclaw , Hope, Rees and Howard .
A recess of a few minutes allowed the committee time to retire and draft resolutions. The following are the resolutions, which were unanimously adopted:
whereas, We have been honored by the presence of Dr. Joseph Jones , Surgeon-General of the United Confederate Veterans and
whereas, We have heard his able report to the illustrious General John B. Gordon , Commanding-General of the United Confederate Veterans , whose presence will also grace this reunion occasion therefore,
Resolved, That we, surviving members of the Medical Corps of the Confederate Army and Navy, and the medical profession, tender to Dr. Jones our gratitude for his very able presentation of the objects to be gained by the assembling of the survivors of the Medical Corps of the Confederate Army and Navy.
Resolved, That he has placed the whole medical profession of the United States under obligations for his self-sacrificing labor in raising from oblivion the priceless statistics relating to the medical history of the Confederate Army and Navy.
Resolved, That we bespeak the earnest co-operation of the surviving surgeons of the Confederate Army and Navy, in his efforts to  procure the imperishable roster his unselfish labors have so auspiciously begun.
Resolved, That a copy of these resolutions be furnished the press for publication.
The following insignia, prepared and presented in silver and gold by Surgeon-General Joseph Jones , will be adopted and worn by the surviving members of the Medical Corps of United Confederate Veterans : Silver disk, one inch in diameter, containing a gold cross, on which are thirteen stars on face inside edge, ‘Medical Corps, C. S. A. and C. S. N., 1861-‘65.’ On reverse—‘ United Confederate Veterans , 1890.’ Name and rank of officer on both faces.
After a short discussion, the meeting adjourned.
The following chairman of committees will look after the visiting physicians from the States which they represent:
During the Middle Ages, hospitals served different functions from modern institutions in that they were almshouses for the poor, hostels for pilgrims, or hospital schools. The word "hospital" comes from the Latin hospes, signifying a stranger or foreigner, hence a guest. Another noun derived from this, hospitium came to signify hospitality, that is the relation between guest and shelterer, hospitality, friendliness, and hospitable reception. By metonymy the Latin word then came to mean a guest-chamber, guest's lodging, an inn.  Hospes is thus the root for the English words host (where the p was dropped for convenience of pronunciation) hospitality, hospice, hostel, and hotel. The latter modern word derives from Latin via the ancient French romance word hostel, which developed a silent s, which letter was eventually removed from the word, the loss of which is signified by a circumflex in the modern French word hôtel. The German word 'Spital' shares similar roots.
Some patients go to a hospital just for diagnosis, treatment, or therapy and then leave ("outpatients") without staying overnight while others are "admitted" and stay overnight or for several days or weeks or months ("inpatients"). Hospitals usually are distinguished from other types of medical facilities by their ability to admit and care for inpatients whilst the others, which are smaller, are often described as clinics.
A standard intensive care unit (ICU) within a hospital
General and acute care Edit
The best-known type of hospital is the general hospital, also known as an acute-care hospital. These facilities handle many kinds of disease and injury, and normally have an emergency department (sometimes known as "accident & emergency") or trauma center to deal with immediate and urgent threats to health. Larger cities may have several hospitals of varying sizes and facilities. Some hospitals, especially in the United States and Canada, have their own ambulance service.
A district hospital typically is the major health care facility in its region, with large numbers of beds for intensive care, critical care, and long-term care.
In California, "district hospital" refers specifically to a class of healthcare facility created shortly after World War II to address a shortage of hospital beds in many local communities.   Even today, district hospitals are the sole public hospitals in 19 of California's counties,  and are the sole locally-accessible hospital within nine additional counties in which one or more other hospitals are present at a substantial distance from a local community.  Twenty-eight of California's rural hospitals and 20 of its critical-access hospitals are district hospitals.  They are formed by local municipalities, have boards that are individually elected by their local communities, and exist to serve local needs.   They are a particularly important provider of healthcare to uninsured patients and patients with Medi-Cal (which is California's Medicaid program, serving low-income persons, some senior citizens, persons with disabilities, children in foster care, and pregnant women).   In 2012, district hospitals provided $54 million in uncompensated care in California. 
A specialty hospital is primarily and exclusively dedicated to one or a few related medical specialties.  Subtypes include rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, long-term acute care facilities and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories such as cardiac, oncology, or orthopedic problems, and so forth.
In Germany specialised hospitals are called Fachkrankenhaus an example is Fachkrankenhaus Coswig (thoracic surgery). In India, specialty hospitals are known as super specialty hospitals, and are distinguished from multispecialty hospitals which are composed of several specialties. 
Specialised hospitals can help reduce health care costs compared to general hospitals. For example, Narayana Health's cardiac unit in Bangalore specialises in cardiac surgery and allows for a significantly greater number of patients. It has 3,000 beds and performs 3,000 in paediatric cardiac operations annually, the largest number in the world for such a facility.   Surgeons are paid on a fixed salary instead of per operation, thus when the number of procedures increases, the hospital is able to take advantage of economies of scale and reduce its cost per procedure.  Each specialist may also become more efficient by working on one procedure like a production line. 
A teaching hospital delivers healthcare to patients as well as training to prospective medical professionals such as medical students and student nurses. It may be linked to a medical school or nursing school, and may be involved in medical research. Students may also observe clinical work in the hospital. 
Clinics generally provide only outpatient services, but some may have a small number of inpatient beds and a limited range of services that may otherwise be found in typical hospitals.
A hospital contains one or more wards that house hospital beds for inpatients. It may also have acute services such as an emergency department, operating theatre, and intensive care unit, as well as a range of medical specialty departments. A well-equipped hospital may be classified as a trauma center. They may also have other services such a hospital pharmacy, radiology, pathology and medical laboratories. Some hospitals have outpatient departments such as behavioral health services, dentistry, and rehabilitation services.
A hospital may also have a department of nursing, headed by a chief nursing officer or director of nursing. This department is responsible for the administration of professional nursing practice, research, and policy for the hospital.
Many units have both a nursing and a medical director that serve as administrators for their respective disciplines within that unit. For example, within an intensive care nursery, a medical director is responsible for physicians and medical care, while the nursing manager is responsible for all of the nurses and nursing care.
Remote monitoring Edit
The COVID-19 pandemic stimulated the development of virtual wards across the British NHS. Patients are managed at home, monitoring their own oxygen levels using an oxygen saturation probe if necessary and supported by telephone. West Hertfordshire Hospitals NHS Trust managed around 1200 patients at home between March and June 2020 and planned to continue the system after COVID-19, initially for respiratory patients.  Mersey Care NHS Foundation Trust started a COVID [email protected] service in April 2020. This enables them to monitor more than 5000 patients a day in their own homes. The technology allows nurses, carers, or patients to record and monitor vital signs such as blood oxygen levels. 
Early examples Edit
In early India, Fa Xian, a Chinese Buddhist monk who travelled across India c. AD 400, recorded examples of healing institutions.  According to the Mahavamsa, the ancient chronicle of Sinhalese royalty, written in the sixth century AD, King Pandukabhaya of Sri Lanka (r. 437–367 BC) had lying-in-homes and hospitals (Sivikasotthi-Sala).  A hospital and medical training centre also existed at Gundeshapur, a major city in southwest of the Sassanid Persian Empire founded in AD 271 by Shapur I.  In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepeion functioned as centres of medical advice, prognosis, and healing.  The Asclepeia spread to the Roman Empire. While public healthcare was non-existent in the Roman Empire, military hospitals called valetudinaria did exist stationed in military barracks and would serve the soldiers and slaves within the fort.  Evidence exists that some civilian hospitals, while unavailable to the Roman population, were occasionally privately built in extremely wealthy Roman households located in the countryside for that family, although this practice seems to have ended in 80 AD. 
Middle Ages Edit
The declaration of Christianity as an accepted religion in the Roman Empire drove an expansion of the provision of care. Following the First Council of Nicaea in AD 325 construction of a hospital in every cathedral town was begun, including among the earliest hospitals by Saint Sampson in Constantinople and by Basil, bishop of Caesarea in modern-day Turkey.  By the twelfth century, Constantinople had two well-organised hospitals, staffed by doctors who were both male and female. Facilities included systematic treatment procedures and specialised wards for various diseases. 
Medical knowledge was transmitted into the Islamic world through the Byzantine Empire.  The earliest general hospital in the Islamic world was built in 805 in Baghdad by Harun Al-Rashid.   By the 10th century, Baghdad had five more hospitals, while Damascus had six hospitals by the 15th century, and Córdoba alone had 50 major hospitals [ when? ] , many exclusively for the military.  The Islamic bimaristan served as a center of medical treatment, as well nursing home and lunatic asylum. It typically treated the poor, as the rich would have been treated in their own homes.  Hospitals in this era were the first to require medical diplomas to license doctors, and compensation for negligence could be made.  [ additional citation(s) needed ] Hospitals were forbidden by law to turn away patients who were unable to pay.  [ need quotation to verify ] These hospitals were financially supported by waqfs,  as well as state funds. 
Early modern and Enlightenment Europe Edit
In Europe the medieval concept of Christian care evolved during the sixteenth and seventeenth centuries into a secular one. In England, after the dissolution of the monasteries in 1540 by King Henry VIII, the church abruptly ceased to be the supporter of hospitals, and only by direct petition from the citizens of London, were the hospitals St Bartholomew's, St Thomas's and St Mary of Bethlehem's (Bedlam) endowed directly by the crown this was the first instance of secular support being provided for medical institutions.
The voluntary hospital movement began in the early 18th century, with hospitals being founded in London by the 1720s, including Westminster Hospital (1719) promoted by the private bank C. Hoare & Co and Guy's Hospital (1724) funded from the bequest of the wealthy merchant, Thomas Guy.
Other hospitals sprang up in London and other British cities over the century, many paid for by private subscriptions. St Bartholomew's in London was rebuilt from 1730 to 1759,  and the London Hospital, Whitechapel, opened in 1752.
These hospitals represented a turning point in the function of the institution they began to evolve from being basic places of care for the sick to becoming centres of medical innovation and discovery and the principal place for the education and training of prospective practitioners. Some of the era's greatest surgeons and doctors worked and passed on their knowledge at the hospitals.  They also changed from being mere homes of refuge to being complex institutions for the provision of medicine and care for sick. The Charité was founded in Berlin in 1710 by King Frederick I of Prussia as a response to an outbreak of plague.
The concept of voluntary hospitals also spread to Colonial America the Bellevue Hospital opened in 1736 (as a workhouse, then later becoming a hospital) the Pennsylvania Hospital opened in 1752, New York Hospital  in 1771, and Massachusetts General Hospital in 1811.
When the Vienna General Hospital opened in 1784 (instantly becoming the world's largest hospital), physicians acquired a new facility that gradually developed into one of the most important research centres. 
Another Enlightenment era charitable innovation was the dispensary these would issue the poor with medicines free of charge. The London Dispensary opened its doors in 1696 as the first such clinic in the British Empire. The idea was slow to catch on until the 1770s,  when many such organisations began to appear, including the Public Dispensary of Edinburgh (1776), the Metropolitan Dispensary and Charitable Fund (1779) and the Finsbury Dispensary (1780). Dispensaries were also opened in New York 1771, Philadelphia 1786, and Boston 1796. 
The Royal Naval Hospital, Stonehouse, Plymouth, was a pioneer of hospital design in having "pavilions" to minimize the spread of infection. John Wesley visited in 1785, and commented "I never saw anything of the kind so complete every part is so convenient, and so admirably neat. But there is nothing superfluous, and nothing purely ornamented, either within or without." This revolutionary design was made more widely known by John Howard, the philanthropist. In 1787 the French government sent two scholar administrators, Coulomb and Tenon, who had visited most of the hospitals in Europe.  They were impressed and the "pavilion" design was copied in France and throughout Europe.
19th century Edit
English physician Thomas Percival (1740–1804) wrote a comprehensive system of medical conduct, Medical Ethics or, a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons (1803) that set the standard for many textbooks.  In the mid-19th century, hospitals and the medical profession became more professionalised, with a reorganisation of hospital management along more bureaucratic and administrative lines. The Apothecaries Act 1815 made it compulsory for medical students to practise for at least half a year at a hospital as part of their training. 
Florence Nightingale pioneered the modern profession of nursing during the Crimean War when she set an example of compassion, commitment to patient care and diligent and thoughtful hospital administration. The first official nurses' training programme, the Nightingale School for Nurses, was opened in 1860, with the mission of training nurses to work in hospitals, to work with the poor and to teach.  Nightingale was instrumental in reforming the nature of the hospital, by improving sanitation standards and changing the image of the hospital from a place the sick would go to die, to an institution devoted to recuperation and healing. She also emphasised the importance of statistical measurement for determining the success rate of a given intervention and pushed for administrative reform at hospitals. 
By the late 19th century, the modern hospital was beginning to take shape with a proliferation of a variety of public and private hospital systems. By the 1870s, hospitals had more than trebled their original average intake of 3,000 patients. In continental Europe the new hospitals generally were built and run from public funds. The National Health Service, the principal provider of health care in the United Kingdom, was founded in 1948. During the nineteenth century, the Second Viennese Medical School emerged with the contributions of physicians such as Carl Freiherr von Rokitansky, Josef Škoda, Ferdinand Ritter von Hebra, and Ignaz Philipp Semmelweis. Basic medical science expanded and specialisation advanced. Furthermore, the first dermatology, eye, as well as ear, nose, and throat clinics in the world were founded in Vienna, being considered as the birth of specialised medicine. 
20th century and beyond Edit
By the late 19th and the beginning 20th century, medical advancements such as anesthesia and sterile techniques that could make surgery less risky, and availability of more advanced diagnostic devices such as X-rays, continued to make hospitals a more attractive option for treatment. 
Modern hospitals measure various efficiency metrics such as occupancy rates, average length of stay, time to service, patient satisfaction, physician performance, patient readmission rate, inpatient mortality rate, and case mix index. 
In the United States, the number of hospitalizations in the United States continued to grow and reached its peak in 1981 with 171 admissions per 1,000 Americans and 6,933 hospitals.  This trend subsequently reversed, with the rate of hospitalization falling by more than 10% and the number of US hospitals shrinking from 6,933 in 1981 to 5,534 in 2016.  Occupancy rates also dropped from 77% in 1980 to 60% in 2013.  Among the reasons for this are the increasing availability of more complex care elsewhere such as at home or at the physicians' offices and also the less therapeutic and more life-threatening image of the hospitals in the eyes of the public.   In the US, a patient may sleep in a hospital bed, but be considered outpatient and "under observation" if not formally admitted.  In the US, inpatient stays are covered under Medicare Part A, but a hospital might keep a patient under observation which is only covered under Medicare Part B, and subjects the patient to additional coinsurance costs.  In 2013, the Center for Medicare and Medicaid Services (CMS) introduced a "two-midnight" rule for inpatient admissions,  intended to reduce an increasing number of long-term "observation" stays being used for reimbursement.  This rule was later dropped in 2018.  In 2016 and 2017, healthcare reform and a continued decline in admissions resulted in US hospital-based healthcare systems performing poorly financially.  Microhospitals, with bed capacities of between eight and fifty, are expanding in the United States.  Similarly, freestanding emergency rooms, which transfer patients that require inpatient care to hospitals, were popularised in the 1970s  and have since expanded rapidly across the United States. 
Modern hospitals derive funding from a variety of sources. They may be funded by public expenditure, charitable donations, or private payment and health insurance.
In the United Kingdom, the National Health Service delivers health care to legal residents funded by the state "free at the point of delivery", and emergency care free to anyone regardless of nationality or status. Due to the need for hospitals to prioritise their limited resources, there is a tendency in countries with such systems for 'waiting lists' for non-crucial treatment, so those who can afford it may take out private health care to access treatment more quickly. 
In the United States, hospitals typically operate privately and in some cases on a for-profit basis, such as HCA Healthcare.  The list of procedures and their prices are billed with a chargemaster however, these prices may be lower for health care obtained within healthcare networks.  Legislation requires hospitals to provide care to patients in life-threatening emergency situations regardless of the patient's ability to pay.  Privately funded hospitals which admit uninsured patients in emergency situations incur direct financial losses, such as in the aftermath of Hurricane Katrina. 
As the quality of health care has increasingly become an issue around the world, hospitals have increasingly had to pay serious attention to this matter. Independent external assessment of quality is one of the most powerful ways to assess this aspect of health care, and hospital accreditation is one means by which this is achieved. In many parts of the world such accreditation is sourced from other countries, a phenomenon known as international healthcare accreditation, by groups such as Accreditation Canada from Canada, the Joint Commission from the US, the Trent Accreditation Scheme from Great Britain, and Haute Authorité de santé (HAS) from France. In England hospitals are monitored by the Care Quality Commission. In 2020 they turned their attention to hospital food standards after seven patient deaths from listeria linked to pre-packaged sandwiches and salads in 2019, saying "Nutrition and hydration is part of a patient’s recovery." 
The World Health Organization noted in 2011 that going into hospital was far riskier than flying. Globally the chance of a patient being subject to an error was about 10% and the chance of death resulting from an error was about 1 in 300 according to Liam Donaldson. 7% of hospitalised patients in developed countries, and 10% in developing countries, acquire at least one health care-associated infection. In the USA 1.7 million infections are acquired in hospital each year, leading to 100,000 deaths, figures much worse than in Europe where there were 4.5 million infections and 37,000 deaths. 
Modern hospital buildings are designed to minimise the effort of medical personnel and the possibility of contamination while maximising the efficiency of the whole system. Travel time for personnel within the hospital and the transportation of patients between units is facilitated and minimised. The building also should be built to accommodate heavy departments such as radiology and operating rooms while space for special wiring, plumbing, and waste disposal must be allowed for in the design. 
However, many hospitals, even those considered "modern", are the product of continual and often badly managed growth over decades or even centuries, with utilitarian new sections added on as needs and finances dictate. As a result, Dutch architectural historian Cor Wagenaar has called many hospitals:
". built catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally unfit for the purpose they have been designed for . They are hardly ever functional, and instead of making patients feel at home, they produce stress and anxiety." 
Some newer hospitals now try to re-establish design that takes the patient's psychological needs into account, such as providing more fresh air, better views and more pleasant colour schemes. These ideas harken back to the late eighteenth century, when the concept of providing fresh air and access to the 'healing powers of nature' were first employed by hospital architects in improving their buildings. 
The research of British Medical Association is showing that good hospital design can reduce patient's recovery time. Exposure to daylight is effective in reducing depression. Single-sex accommodation help ensure that patients are treated in privacy and with dignity. Exposure to nature and hospital gardens is also important – looking out windows improves patients' moods and reduces blood pressure and stress level. Open windows in patient rooms have also demonstrated some evidence of beneficial outcomes by improving airflow and increased microbial diversity.   Eliminating long corridors can reduce nurses' fatigue and stress. 
Another ongoing major development is the change from a ward-based system (where patients are accommodated in communal rooms, separated by movable partitions) to one in which they are accommodated in individual rooms. The ward-based system has been described as very efficient, especially for the medical staff, but is considered to be more stressful for patients and detrimental to their privacy. A major constraint on providing all patients with their own rooms is however found in the higher cost of building and operating such a hospital this causes some hospitals to charge for private rooms. 
+20 Free Anatomy Books [PDF]
The study of human morphology is always something complicated and requires a structured analysis. With this in mind, we offer a series of anatomy books in PDF format to those interested in the subject.
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Anatomy books provide you with all the information required for the study of the human and animal body or plant structure. They explain each of the parts of the body, the organs and the different systems that make up living organisms.
Here you can find more than 20 anatomy books in PDF format, which will help you understand the structure and morphology of living organisms.
17. University of Michigan Ann Arbor
The University of Michigan – Ann Arbor has been one of the most respected medical schools in the US since it first opened its doors in 1850. Offering 20 clinical and nine basic science departments, the school graduates approximately 170 physicians annually, all of whom have the opportunity to participate in the school’s global activities through programs such as Global REACH before they leave. Coming it at 17th overall, the university ranks #6 for training primary care physicians, #3 for family medicine specialty, #6 for surgery specialty, and #3 for residency director reputation score among primary care schools.
1. EMCrit Podcast | Critical Care and Resuscitation
About Podcast EMCrit Podcast is the online medical education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation. Stay tuned to listen to the latest updates and information on critical care and resuscitation. Frequency 2 episodes / month , Average Episode Length 29 min Also in Critical Care Podcasts Podcast emcrit.org/category/emcrit
Facebook fans 35.4K ⋅ Twitter followers 67.2K ⋅ Social Engagement 545 ⓘ ⋅ Domain Authority 53 ⓘ ⋅ View Latest Episodes ⋅ Get Email Contact
2. Run the List
About Podcast Run the List is a medical education podcast designed for medical students and all learners hoping for a review in internal medicine. Our show is comprised of short episodes through which you can learn about the diagnosis, management, and clinical pearls for common internal medicine problems. Frequency 1 episode / month , Average Episode Length 26 min Since Aug 2019 Also in Internal Medicine Podcasts Podcast anchor.fm/run-the-list
Twitter followers 5K ⋅ Domain Authority 81 ⓘ ⋅ Alexa Rank 1.9K ⓘ View Latest Episodes ⋅ Get Email Contact
3. Medical Education Podcasts
About Podcast Medical Education Podcasts is a podcast from the journal Medical Education. Stay tuned to listen to the latest news about medical education. Frequency 4 episodes / week , Average Episode Length 27 min Podcast medicaleducation.podbean.com
Domain Authority 86 ⓘ ⋅ View Latest Episodes ⋅ Get Email Contact
4. Curbside to Bedside
Kentucky, United States About Podcast Curbside to Bedside is about providing useful, up-to-date Prehospital medical education to front line EMS Providers. Whether an adjunct for the Paramedic student or a refresher for the seasoned clinician, you'll find fresh content that you can apply to your current practice. Frequency 3 episodes / year , Average Episode Length 48 min Podcast curbtobed.com/archives
Facebook fans 696 ⋅ Twitter followers 278 ⋅ Instagram Followers 201 ⋅ Domain Authority 7 ⓘ ⋅ View Latest Episodes ⋅ Get Email Contact
About Podcast Mountainlion is a medical education focused podcast that will make you a better learner and teacher. Frequency 2 episodes / month , Average Episode Length 57 min Podcast soundcloud.com/mountainlion-2
Domain Authority 93 ⓘ ⋅ Alexa Rank 93 ⓘ View Latest Episodes ⋅ Get Email Contact
6. Trauma ICU Rounds
Long Beach, California, United States About Podcast Medical education podcast dedicated to providing high-quality, concise, and clinically relevant multimedia content spanning the spectrum of surgical critical care, emergency general & trauma surgery. Frequency 1 episode / week , Average Episode Length 36 min Since Mar 2020 Podcast feeds.buzzsprout.com/753806
Twitter followers 7K ⋅ Domain Authority 77 ⓘ ⋅ Alexa Rank 4K ⓘ View Latest Episodes ⋅ Get Email Contact
7. MEM Cast
About Podcast A series of education podcasts for core medical trainees and medical students covering the whole curriculum for the MRCP exam. Frequency 1 episode / week , Average Episode Length 19 min Podcast podomatic.com/podcasts/medea..
Domain Authority 84 ⋅ Alexa Rank 27.9K View Latest Episodes ⋅ Get Email Contact
8. Stanford Medcast
About Podcast Medcast is the new Stanford CME Podcast sharing insights from the world's leading physicians and scientists. Frequency 2 episodes / month , Average Episode Length 28 min Podcast stanfordmedcast.podbean.com
Domain Authority 88 ⋅ View Latest Episodes ⋅ Get Email Contact
9. Two Paeds In A Pod
London, England, United Kingdom About Podcast Home of the 'Two Paeds In a Pod' Podcast from the Department of Paediatrics at the Royal Derby Hospital. Created by Sarah Simons, Geoff Burnhill and Ian Lewins this medical education podcast is aimed at health care professionals new to pediatrics or those who occasionally care for children as part of a wider healthcare role. This podcast is for medical education purposes only and should not replace the advice you have received from a medical practitioner. Frequency 1 episode / month , Average Episode Length 28 min Podcast soundcloud.com/user-663288011
Twitter followers 27.1K ⋅ Instagram Followers 1.4K ⋅ Social Engagement 4 ⋅ Domain Authority 93 ⋅ Alexa Rank 142 View Latest Episodes ⋅ Get Email Contact
10. NEI Podcast
Carlsbad, California, United States About Podcast The Neuroscience Education Institute (NEI) is committed to help raise the standard of mental health by providing imaginative medical education that focuses on the highest level of learning. Each episode offers an opportunity to learn about current issues in psychiatry from key opinion leaders in the medical field. NEI's Podcast would be of value to anyone with an interest in neuropsychiatric diseases and psychopharmacology. Frequency 1 episode / week , Average Episode Length 43 min Since May 2017 Also in Neuroscience Podcasts, Psychiatry Podcasts Podcast neiglobal.libsyn.com
Facebook fans 12.3K ⋅ Twitter followers 32 ⋅ Social Engagement 5 ⋅ Domain Authority 17 ⋅ Alexa Rank 4.6K View Latest Episodes ⋅ Get Email Contact
11. DocWorking: The Whole Physician Podcast
United States About Podcast As physicians, we make decisions every day about how to prioritize our time, energy, focus, attention, and money. Hosts Jen Barna MD, Coach Gabriella Dennery MD and Master Certified Coach Jill Farmer interview physicians to explore ways to embrace life AND a medical career, some who've chosen a path less traveled and others who have optimized their lives on a traditional medical career path. Frequency 1 episode / day , Average Episode Length 20 min Since Feb 2021 Also in Healthcare Industry and News Podcasts, Doctor Podcasts, Physicians Podcasts, Medical Podcasts Podcast docworking.podbean.com
Twitter followers 580 ⋅ Domain Authority 89 ⋅ View Latest Episodes ⋅ Get Email Contact
12. Boggled Docs
United Kingdom About Podcast The podcast for GPs and other primary care professionals using the medical media as a springboard to help you target your CPD. In each episode, we'll look at the general picture of what's going on in the newspaper health pages, daytime TV, online, and even radio if it's relevant. Nothing's off-limits and some of the big TV dramas will get a look in too. We'll also take some time to chat with a fellow medical colleague about a featured programme in more detail. Frequency 1 episode / week , Average Episode Length 45 min Since Oct 2020 Podcast feeds.buzzsprout.com/1300702
Twitter followers 929 ⋅ Domain Authority 77 ⋅ Alexa Rank 4K View Latest Episodes ⋅ Get Email Contact
Ottawa, Ontario, Canada About Podcast Key Literature in Medical Education (KeyLIME) is a bi-weekly podcast produced by the Royal College of Physicians and Surgeons of Canada. Bringing you the main points of a medical education article in just 20 minutes. Articles that are important, innovative, or will impact your educational practice are discussed. Frequency 1 episode / week , Average Episode Length 32 min Since Jan 2012 Podcast keylimepodcast.libsyn.com
Facebook fans 29 ⋅ Twitter followers 8.3K ⋅ Domain Authority 30 ⋅ Alexa Rank 4.7K View Latest Episodes ⋅ Get Email Contact
14. Zero To Finals Podcast
United Kingdom About Podcast Hello and welcome to the Zero to Finals podcast. My name is Dr. Thomas Watchman. I am a GP in the UK and I love creating educational material for studying medicine. This podcast is designed to be a time-efficient revision tool to help you study for your medical exams. Each podcast leads on from the next and each season tackles a different area of medicine. Frequency 3 episodes / week , Average Episode Length 6 min Since Nov 2018 Also in UK Education Podcasts Podcast zerotofinals.com/podcast
Twitter followers 1.4K ⋅ Social Engagement 2 ⋅ Domain Authority 15 ⋅ Alexa Rank 1.2M View Latest Episodes ⋅ Get Email Contact
15. NB Medical Education
United Kingdom About Podcast The Hot Topics podcast from NB Medical brings you the latest in general practice current affairs, reviews the latest research relevant to primary care, explores interesting and important topics in-depth, and looks at cutting edge medicine. Frequency 2 episodes / month , Average Episode Length 22 min Podcast nbmedical.com/NBPodcasts
Facebook fans 5.9K ⋅ Twitter followers 4.8K ⋅ Instagram Followers 82 ⋅ Domain Authority 29 ⋅ View Latest Episodes ⋅ Get Email Contact
16. Penn Medicine's TTM Academy Podcasts
Philadelphia, Pennsylvania, United States About Podcast Welcome to Penn Medicine's TTM Academy Podcast! TTM Academy podcasts are intended for medical education only and should not be used for clinical decision making. Stay tuned to listen th the latest updates. Frequency 2 episodes / quarter , Average Episode Length 29 min Podcast ttmacademy.podbean.com
Facebook fans 69 ⋅ Twitter followers 620 ⋅ Social Engagement 3 ⋅ Domain Authority 86 ⋅ View Latest Episodes ⋅ Get Email Contact
Review: Volume 20 - Medical History - History
Ballot Title: An amendment to the Colorado Constitution authorizing the medical use of marijuana for persons suffering from debilitating medical conditions, and, in connection therewith, establishing an affirmative defense to Colorado criminal laws for patients and their primary care-givers relating to the medical use of marijuana establishing exceptions to Colorado criminal laws for patients and primary care-givers in lawful possession of a registry identification card for medical marijuana use and for physicians who advise patients or provide them with written documentation as to such medical marijuana use defining "debilitating medical condition" and authorizing the state health agency to approve other medical conditions or treatments as debilitating medical conditions requiring preservation of seized property interests that had been possessed, owned, or used in connection with a claimed medical use of marijuana and limiting forfeiture of such interests establishing and maintaining a confidential state registry of patients receiving an identification card for the medical use of marijuana and defining eligibility for receipt of such a card and placement on the registry restricting access to information in the registry establishing procedures for issuance of an identification card authorizing fees to cover administrative costs associated with the registry specifying the form and amount of marijuana a patient may possess and restrictions on its use setting forth additional requirements for the medical use of marijuana by patients less than eighteen years old directing enactment of implementing legislation and criminal penalties for certain offenses requiring the state health agency designated by the governor to make application forms available to residents of Colorado for inclusion on the registry limiting a health insurer's liability on claims relating to the medical use of marijuana and providing that no employer must accommodate medical use of marijuana in the workplace.
Text of Proposed Constitutional Amendment:
Be it Enacted by the People of the State of Colorado:
AN AMENDMENT TO THE CONSTITUTION OF THE STATE OF COLORADO, AMENDING ARTICLE XVIII, ADDING A NEW SECTION TO READ:
Section 14. Medical use of marijuana for persons suffering from debilitating medical conditions.
(1) As used in this section, these terms are defined as follows. (a) "Debilitating medical condition" means: (I) Cancer, glaucoma, positive status for human immunodeficiency virus, or acquired immune deficiency syndrome, or treatment for such conditions (II) A chronic or debilitating disease or medical condition, or treatment for such conditions, which produces, for a specific patient, one or more of the following, and for which, in the professional opinion of the patient's physician, such condition or conditions reasonably may be alleviated by the medical use of marijuana: cachexia severe pain severe nausea seizures, including those that are characteristic of epilepsy or persistent muscle spasms, including those that are characteristic of multiple sclerosis or (III) Any other medical condition, or treatment for such condition, approved by the state health agency, pursuant to its rule making authority or its approval of any petition submitted by a patient or physician as provided in this section. (b) "Medical use" means the acquisition, possession, production, use, or transportation of marijuana or paraphernalia related to the administration of such marijuana to address the symptoms or effects of a patient's debilitating medical condition, which may be authorized only after a diagnosis of the patient's debilitating medical condition by a physician or physicians, as provided by this section. (c) "Parent" means a custodial mother or father of a patient under the age of eighteen years, any person having custody of a patient under the age of eighteen years, or any person serving as a legal guardian for a patient under the age of eighteen years. (d) "Patient" means a person who has a debilitating medical condition. (e) "Physician" means a doctor of medicine who maintains, in good standing, a license to practice medicine issued by the state of Colorado. (f) "Primary care-giver" means a person, other than the patient and the patient's physician, who is eighteen years of age or older and has significant responsibility for managing the well-being of a patient who has a debilitating medical condition. (g) "Registry identification card" means that document, issued by the state health agency, which identifies a patient authorized to engage in the medical use of marijuana and such patient's primary care-giver, if any has been designated. (h) "State health agency" means that public health related entity of state government designated by the governor to establish and maintain a confidential registry of patients authorized to engage in the medical use of marijuana and enact rules to administer this program. (i) "Usable form of marijuana" means the seeds, leaves, buds, and flowers of the plant (genus) cannabis, and any mixture or preparation thereof, which are appropriate for medical use as provided in this section, but excludes the plant's stalks, stems, and roots. (j) "Written documentation" means a statement signed by a patient's physician or copies of the patient's pertinent medical records.
(2) (a) Except as otherwise provided in subsections (5), (6), and (8) of this section, a patient or primary care-giver charged with a violation of the state's criminal laws related to the patient's medical use of marijuana will be deemed to have established an affirmative defense to such allegation where: (I) The patient was previously diagnosed by a physician as having a debilitating medical condition (II) The patient was advised by his or her physician, in the context of a bona fide physician-patient relationship, that the patient might benefit from the medical use of marijuana in connection with a debilitating medical condition and (III) The patient and his or her primary care-giver were collectively in possession of amounts of marijuana only as permitted under this section. This affirmative defense shall not exclude the assertion of any other defense where a patient or primary care-giver is charged with a violation of state law related to the patient's medical use of marijuana. (b) Effective June 1, 1999, it shall be an exception from the state's criminal laws for any patient or primary care-giver in lawful possession of a registry identification card to engage or assist in the medical use of marijuana, except as otherwise provided in subsections (5) and (8) of this section. (c) It shall be an exception from the state's criminal laws for any physician to: (I) Advise a patient whom the physician has diagnosed as having a debilitating medical condition, about the risks and benefits of medical use of marijuana or that he or she might benefit from the medical use of marijuana, provided that such advice is based upon the physician's contemporaneous assessment of the patient's medical history and current medical condition and a bona fide physician-patient relationship or (II) Provide a patient with written documentation, based upon the physician's contemporaneous assessment of the patient's medical history and current medical condition and a bona fide physician-patient relationship, stating that the patient has a debilitating medical condition and might benefit from the medical use of marijuana. No physician shall be denied any rights or privileges for the acts authorized by this subsection. (d) Notwithstanding the foregoing provisions, no person, including a patient or primary care-giver, shall be entitled to the protection of this section for his or her acquisition, possession, manufacture, production, use, sale, distribution, dispensing, or transportation of marijuana for any use other than medical use. (e) Any property interest that is possessed, owned, or used in connection with the medical use of marijuana or acts incidental to such use, shall not be harmed, neglected, injured, or destroyed while in the possession of state or local law enforcement officials where such property has been seized in connection with the claimed medical use of marijuana. Any such property interest shall not be forfeited under any provision of state law providing for the forfeiture of property other than as a sentence imposed after conviction of a criminal offense or entry of a plea of guilty to such offense. Marijuana and paraphernalia seized by state or local law enforcement officials from a patient or primary care-giver in connection with the claimed medical use of marijuana shall be returned immediately upon the determination of the district attorney or his or her designee that the patient or primary care-giver is entitled to the protection contained in this section as may be evidenced, for example, by a decision not to prosecute, the dismissal of charges, or acquittal.
(3) The state health agency shall create and maintain a confidential registry of patients who have applied for and are entitled to receive a registry identification card according to the criteria set forth in this subsection, effective June 1, 1999. (a) No person shall be permitted to gain access to any information about patients in the state health agency's confidential registry, or any information otherwise maintained by the state health agency about physicians and primary care-givers, except for authorized employees of the state health agency in the course of their official duties and authorized employees of state or local law enforcement agencies which have stopped or arrested a person who claims to be engaged in the medical use of marijuana and in possession of a registry identification card or its functional equivalent, pursuant to paragraph (e) of this subsection (3). Authorized employees of state or local law enforcement agencies shall be granted access to the information contained within the state health agency's confidential registry only for the purpose of verifying that an individual who has presented a registry identification card to a state or local law enforcement official is lawfully in possession of such card. (b) In order to be placed on the state's confidential registry for the medical use of marijuana, a patient must reside in Colorado and submit the completed application form adopted by the state health agency, including the following information, to the state health agency: (I) The original or a copy of written documentation stating that the patient has been diagnosed with a debilitating medical condition and the physician's conclusion that the patient might benefit from the medical use of marijuana (II) The name, address, date of birth, and social security number of the patient (III) The name, address, and telephone number of the patient's physician and (IV) The name and address of the patient's primary care-giver, if one is designated at the time of application. (c) Within thirty days of receiving the information referred to in subparagraphs (3)(b)(I)-(IV), the state health agency shall verify medical information contained in the patient's written documentation. The agency shall notify the applicant that his or her application for a registry identification card has been denied if the agency's review of such documentation discloses that: the information required pursuant to paragraph (3)(b) of this section has not been provided or has been falsified the documentation fails to state that the patient has a debilitating medical condition specified in this section or by state health agency rule or the physician does not have a license to practice medicine issued by the state of Colorado. Otherwise, not more than five days after verifying such information, the state health agency shall issue one serially numbered registry identification card to the patient, stating: (I) The patient's name, address, date of birth, and social security number (II) That the patient's name has been certified to the state health agency as a person who has a debilitating medical condition, whereby the patient may address such condition with the medical use of marijuana (III) The date of issuance of the registry identification card and the date of expiration of such card, which shall be one year from the date of issuance and (IV) The name and address of the patient's primary care-giver, if any is designated at the time of application. (d) Except for patients applying pursuant to subsection (6) of this section, where the state health agency, within thirty-five days of receipt of an application, fails to issue a registry identification card or fails to issue verbal or written notice of denial of such application, the patient's application for such card will be deemed to have been approved. Receipt shall be deemed to have occurred upon delivery to the state health agency, or deposit in the United States mails. Notwithstanding the foregoing, no application shall be deemed received prior to June 1, 1999. A patient who is questioned by any state or local law enforcement official about his or her medical use of marijuana shall provide a copy of the application submitted to the state health agency, including the written documentation and proof of the date of mailing or other transmission of the written documentation for delivery to the state health agency, which shall be accorded the same legal effect as a registry identification card, until such time as the patient receives notice that the application has been denied. (e) A patient whose application has been denied by the state health agency may not reapply during the six months following the date of the denial and may not use an application for a registry identification card as provided in paragraph (3)(d) of this section. The denial of a registry identification card shall be considered a final agency action. Only the patient whose application has been denied shall have standing to contest the agency action. (f) When there has been a change in the name, address, physician, or primary care-giver of patient who has qualified for a registry identification card, that patient must notify the state health agency of any such change within ten days. A patient who has not designated a primary care-giver at the time of application to the state health agency may do so in writing at any time during the effective period of the registry identification card, and the primary care-giver may act in this capacity after such designation. To maintain an effective registry identification card, a patient must annually resubmit, at least thirty days prior to the expiration date stated on the registry identification card, updated written documentation to the state health agency, as well as the name and address of the patient's primary care-giver, if any is designated at such time. (g) Authorized employees of state or local law enforcement agencies shall immediately notify the state health agency when any person in possession of a registry identification card has been determined by a court of law to have willfully violated the provisions of this section or its implementing legislation, or has pled guilty to such offense. (h) A patient who no longer has a debilitating medical condition shall return his or her registry identification card to the state health agency within twenty-four hours of receiving such diagnosis by his or her physician. (i) The state health agency may determine and levy reasonable fees to pay for any direct or indirect administrative costs associated with its role in this program.
(4) (a) A patient may engage in the medical use of marijuana, with no more marijuana than is medically necessary to address a debilitating medical condition. A patient's medical use of marijuana, within the following limits, is lawful: (I) No more than two ounces of a usable form of marijuana and (II) No more than six marijuana plants, with three or fewer being mature, flowering plants that are producing a usable form of marijuana. (b) For quantities of marijuana in excess of these amounts, a patient or his or her primary care-giver may raise as an affirmative defense to charges of violation of state law that such greater amounts were medically necessary to address the patient's debilitating medical condition.
(5) (a) No patient shall: (I) Engage in the medical use of marijuana in a way that endangers the health or well-being of any person or (II) Engage in the medical use of marijuana in plain view of, or in a place open to, the general public. (b) In addition to any other penalties provided by law, the state health agency shall revoke for a period of one year the registry identification card of any patient found to have willfully violated the provisions of this section or the implementing legislation adopted by the general assembly.
(6) Notwithstanding paragraphs (2)(a) and (3)(d) of this section, no patient under eighteen years of age shall engage in the medical use of marijuana unless: (a) Two physicians have diagnosed the patient as having a debilitating medical condition (b) One of the physicians referred to in paragraph (6)(a) has explained the possible risks and benefits of medical use of marijuana to the patient and each of the patient's parents residing in Colorado (c) The physicians referred to in paragraph (6)(b) has provided the patient with the written documentation, specified in subparagraph (3)(b)(I) (d) Each of the patient's parents residing in Colorado consent in writing to the state health agency to permit the patient to engage in the medical use of marijuana (e) A parent residing in Colorado consents in writing to serve as a patient's primary care-giver (f) A parent serving as a primary care-giver completes and submits an application for a registry identification card as provided in subparagraph (3)(b) of this section and the written consents referred to in paragraph (6)(d) to the state health agency (g) The state health agency approves the patient's application and transmits the patient's registry identification card to the parent designated as a primary care-giver (h) The patient and primary care-giver collectively possess amounts of marijuana no greater than those specified in subparagraph (4)(a)(I) and (II) and (i) The primary care-giver controls the acquisition of such marijuana and the dosage and frequency of its use by the patient.
(7) Not later than March 1, 1999, the governor shall designate, by executive order, the state health agency as defined in paragraph (1)(g) of this section.
(8) Not later than April 30, 1999, the General Assembly shall define such terms and enact such legislation as may be necessary for implementation of this section, as well as determine and enact (a) Fraudulent representation of a medical condition by a patient to a physician, state health agency, or state or local law enforcement official for the purpose of falsely obtaining a registry identification card or avoiding arrest and prosecution (b) Fraudulent use or theft of any person's registry identification card to acquire, possess, produce, use, sell, distribute, or transport marijuana, including but not limited to cards that are required to be returned where patients are no longer diagnosed as having a debilitating medical condition (c) Fraudulent production or counterfeiting of, or tampering with, one or more registry identification cards or (d) Breach of confidentiality of information provided to or by the state health agency.
(9) Not later than June 1, 1999, the state health agency shall develop and make available to residents of Colorado an application form for persons seeking to be listed on the confidential registry of patients. By such date, the state health agency shall also enact rules of administration, including but not limited to rules governing the establishment and confidentiality of the registry, the verification of medical information, the issuance and form of registry identification cards, communications with law enforcement officials about registry identification cards that have been suspended where a patient is no longer diagnosed as having a debilitating medical condition, and the manner in which the agency may consider adding debilitating medical conditions to the list provided in this section. Beginning June 1, 1999, the state health agency shall accept physician or patient initiated petitions to add debilitating medical conditions to the list provided in this section and, after such hearing as the state health agency deems appropriate, shall approve or deny such petitions within one hundred eighty days of submission. The decision to approve or deny a petition shall be considered a final agency action.
(10) (a) No governmental, private, or any other health insurance provider shall be required to be liable for any claim for reimbursement for the medical use of marijuana. (b) Nothing in this section shall require any employer to accommodate the medical use of marijuana in any work place.
(11) Unless otherwise provided by this section, all provisions of this section shall become effective upon official declaration of the vote hereon by proclamation of the governor, pursuant to article V, section (1)(4), and shall apply to acts or offenses committed on or after that date.
Peer review and ‘Impact Factor’
Generally, medical journals are classified by their peer review process and Impact Factor.
The peer review process acts as a check and balance on the original work. Having a peer critique the article helps to ensure that the information and investigation covered in the work is factually sound and is also relevant to the target audience. The process improves the quality of published papers, and better quality articles get published in better quality journals.
The peer review process involves three stages: 1) Evaluation – the article receives an initial evaluation by the chief editor, 2) Blind review – experts in the same field but who don’t know the author review the article, and 3) Revisions – the article is returned to the author for revision if it’s been accepted. Once this process is complete, publishing editors are offered added assurance that the work meets their standards for publication.
In terms of Impact Factor, the higher the impact, the more reliable the journal. When it comes to scholarly articles, impact is measured by the amount of times the article is cited by other indexed publications. The Impact Factor result is a number – for example 55.9 – that’s calculated by dividing the total number of ‘citable’ items published by a journal in a given year, by the actual number of times that all published items in that journal were cited by other indexed journals.
Medical journals are indexed by the Web of Science. 2019 impact factors will be calculated and published in 2020 when all 2019 publications have been indexed. New journals receive an Impact Factor after three years of indexing/publication. Annual or irregular journals sometimes don’t publish items in a specific year, affecting the count. A journal that published more cited articles over a 2-year period will have the highest Impact Factor.
A list is collated every year of the top medical journals according to Impact Factors, and the top six are described here:
1. New England Journal of Medicine
According to the Journal’s website, the New England Journal of Medicine (NEJM) “is the world’s leading medical journal and website”.
More than 600,000 people around the world read the New England Journal of Medicine each week and it’s the most often cited journal in scientific literature. In 2018, it had the highest Impact Factor ( 70.670) of all general medical journals, ranking first.
The NEJM offers physicians and educators research and key information regarding biomedical science and clinical practice. It provides this information in an understandable way that’s easy to put into practice.
Its editorial team uses strict editorial, peer and statistical review processes to evaluate manuscripts submitted for publication. As well as screening for scientific accuracy, novelty and importance, they make sure that the authors have disclosed all relevant financial associations to ensure the content is free from outside influences.
NEJM receives over 16,000 submissions a year for consideration, with only around 5% actually achieving publication and more than half of those originating from outside the USA. And to ensure that everyone can benefit from their content, NEJM offers free online access to more than 90 low income countries, with articles available six months after they’re originally published.
2. The Lancet
The Lancet is just one of ten journals published by Elsevier. The specialty monthly journal covers topics such as diabetes and endocrinology, global health, haematology, HIV, infectious diseases, neurology, oncology, psychiatry and respiratory medicine.
On its own, The Lancet has an impact rating of 59.102 and is ranked 2nd out of 160 journals in the Medicine, General and Internal category. The journal is available in print, online and on mobile – and it’s interactive!
It has been home to a number of ground-breaking articles that have had a significant impact on the areas of science and human health. The Lancet takes pride in being independent of all societal and political bodies.
Since its first issue in 1823, the Lancet has sought to make science and medicine as widely available as possible in order to transform society and positively impact people’s lives.
The editorial team sets very high standards, choosing only the best research papers based on their quality and their relevance in terms of improving human lives.
A good example is the recent paper they published on the Firehawk Stent System, the first ever Chinese medical instrument recognised by the Lancet, and one which has solved a major problem in the field of cardiovascular studies.
The Lancet aims to increase the social impact of science and does so by setting agendas, creating context, informing leaders, starting debates and advocating for the idea that research can make a real difference in the world.
3. The Journal of the American Medical Association
The Journal of the American Medical Association (JAMA) is one of ten medical journals published by the JAMA Network.
In 2018, JAMA had an Impact Factor of 51.273, ranking it 3rd out of 160 journals in the category “Medicine, General and Internal”, and according to its website, “is the most widely circulated medical journal in the world, with more than 286,000 recipients of the print journal, more than 1.3 million recipients of electronic tables of contents and alerts, and nearly 27 million annual visits to the journal’s website.”
JAMA publishes peer-reviewed articles on a range of medical topics and helps to keep physicians informed across all aspects of medical care, including developments outside of their own field.
The JAMA network includes journals on a variety of different fields encompassing cardiology, dermatology, facial plastic surgery, internal medicine, neurology, oncology, ophthalmology, head & neck surgery, paediatrics and psychiatry.
Its websites include topics as diverse as:
- The AMA Manual of Style – a style guide for authors and editors.
- Art and Images in Psychiatry – a collection of essays exploring the role of the visual arts in representing truths about mental illness.
- Breast Cancer Screening Guidelines – an updated guideline from the American Cancer Society on recommended breast cancer screening for women at average risk.
- Declaration of Helsinki – ethical principles for medical research.
- Fishbein Fellowship – a one-year fellowship in medical editing offered by JAMA to introduce physicians to editing and publishing a major medical journal.
- Genomics and Precision Health – the latest developments on precision medicine the approach that matches treatments to patients based on individual genetic variability.
- Opioid Management Guidelines – a collection of articles on opioids.
- Topics and Collections – collections of content from JAMA and their specialty journals.
4. The British Medical Journal
The British Medical Journal (BMJ) has been published since 1840, when it began life as the Provincial Medical and Surgical Journal. Its stated aim is to lead the debate on health and to engage, inform and stimulate health professionals to improve outcomes for their patients.
The British Medical Journal had an Impact Factor of 27.604 in 2018, ranking it 4th among general medical journals, and is one of 55 medical and science journals published by BMJ the company.
It publishes articles, news, letters, investigative journalism and commentary on the factors that help doctors to make better clinical, research and public health decisions.
The BMJ has reported on some notable developments in the medical field. Some of the outstanding articles they have featured include: the discovery of chloroform, which was used during the birth of Queen Victoria’s eighth child an expose on baby farming the first X-ray image made in Britain and the link between smoking and lung cancer.
5. JAMA Internal Medicine
Formerly known as the Archives of Internal Medicine, JAMA Internal Medicine covers general internal medicine and specialty internal medicine areas. Articles published in JAMA Internal Medicine are peer-reviewed and are designed to provide insightful research to educate and inform readers.
With an Impact Factor of 20.768 in 2018, JAMA Internal Medicine ranks 5th out of 160 journals in the Medicine, General and Internal category. The journal receives approximately 7.5 million online visits a year and over 9.3 million article views and downloads.
JAMA Internal Medicine is part of the JAMA Network of journals that includes JAMA, 11 JAMA Network specialty journals, and JAMA Network Open. The journal receives regular attention from major media and articles it has published have led to legislative action by US authorities on matters of patient safety and better public protection measures.
6. Annals of Internal Medicine
Annals of Internal Medicine was established by the American College of Physicians in 1927 and is today one of the most influential journals in the world.
It publishes a wide variety of research, peer reviewed articles, practice guidelines and commentary relevant to clinical practice, healthcare policy and delivery, medical education, ethics and research methodology. It also publishes personal stories of doctors from around the globe to help convey the personal nature of medicine.
Annals of Internal Medicine has over 159,000 readers and its Impact Factor for 2018 was 19.315, ranking it 6th out of 160 journals. It also had 57,057 total cites, making it the most cited general internal medicine journal in the world.
The journal’s mission is to promote excellence in medicine, keep physicians and healthcare professionals well informed, improve standards in the reporting of medical research, and contribute to the improvement of worldwide health.
All material published in Annals of Internal Medicine is subject to peer review with the help of more than 18,000 volunteers worldwide and acceptance rates for submissions are around 6-8%.
In line with its commitment to readers and authors, the journal provides free access to many of its articles and all issues are made freely available to countries with developing economies.
Standard Medical Freezers
All of these medical freezers are capable of operating at -20°C, which is the required set temperature for most frozen products used in a medical environment. For some products, the temperature will need to be a little lower than this, and for these applications, we suggest that you look at our selection of European made Liebherr freezers.
ENLAKE's medical-grade freezers can be depended upon to maintain your products at the right temperature. All of these medical freezers have digital controllers, audible warnings if the freezer goes out of the specified range and door locks. There are many other options available such as data loggers and SMS alert systems, and we can even manufacture a freezer to your specification. Consult our product specialist on 1800 094 259 to discuss all your requirements.
NULINE HF200 130 Litre Medical Freezer – Solid Door
NULINE HF200 130 Litre Medical Freezer featuring: Digital temperature indicator, Door lock and Built-in alarm.
Out of Stock - Call us to pre order. Expected August. 1800 094 259.
LIEBHERR LGUex 1500 Laboratory Freezer – 139 litres
LIEBHERR LGUex 1500 Laboratory Freezer – 139 litres, Solid door, Static freezer, Spark free interior, Comfort Controller, Made in Austria.
Out of Stock - Call us to pre order. Expected August. 1800 094 259.
Nuline MLF -40°C Freezer – 115 litres
The MLF -40°C Freezer provides the reliability that you need for your valuable items. The static refrigeration system keeps an.
Thermoline Scientific TF-90-SP Static Defrost -20°C Freezer – 90 litres
A small under the counter style Thermoline freezer that is ideal for lab samples requiring storage at -20°C. This small
LIEBHERR LGex 3410 Medical Freezer – 310 litres
LIEBHERR LGex 3410 Medical Freezer – Solid door, Static freezer, Spark free interior, Comfort Controller, Made in Austria.
NULINE HF400 350 litre Medical Freezer – Solid Door
NULINE HF400 350 litre Medical Freezer featuring: Digital temperature indicator, Door lock, Spark free interior and Built-in alarm.
Out of Stock - Call us to pre order. Expected early July. 1800 094 259.
Liebherr LGv 5010 Medical and Laboratory Freezer – 478 litres
The European Liebherr LGv 5010 is a 478-litre freezer with 10 drawers and two smaller baskets. This freezer features an.